Healthcare Design - April 2015 - 38

R RESEARCH | 04.15
All in
For many providers, the solution to population health management is a shift to coordinated,
team-based care in an open work environment. A literature review and real-world observations
evaluate models in use and effects on staff communication and collaboration
By Jennifer DuBose and Ross Westlake
U.S. healthcare systems are moving away from
episodic care delivered in silos to coordinated, teambased care that improves population health. One
model, the patient-centered medical home (PCMH),
is supported by the National Committee for Quality
Assurance, though other groups and systems are
creating similar systems with the goal of providing:
t $PNQSFIFOTJWFQSJNBSZDBSFUIBUIFMQTQBUJFOUT
stay well and manage chronic disease
t $BSFUIBUEFWFMPQTMPOHUFSNSFMBUJPOTIJQTXJUIQBtients rather than focuses on transactional medicine
made up of individual clinical encounters
t 1SPBDUJWFQPQVMBUJPOIFBMUINBOBHFNFOUJOTUFBEPG
reactive individual care
t $BSFCZBNVMUJEJTDJQMJOBSZUFBNUIBUJODMVEFT
physicians, care coordinators, nurses, medical assistants, pharmacists, behavioral health specialists,
dieticians, and others
t $PPSEJOBUFEDBSFCZIJHIQFSGPSNJOHUFBNTUIBU
allows team members to contribute at the highest
level of their own expertise and communicate effectively through electronic medical records and
face-to-face communication.
This kind of proactive, team-based model helps to
reduce cost, improve outcomes, and improve patient
experience.
Although necessary to the PCMH model, the move
from physician-centered practices to practices where
a physician leads a care team is proving particularly
challenging, largely because the healthcare industry
today has well-established roles and hierarchies and
is reluctant to change.
To answer the trend of physicians shifting from
independent practices to salaried employees of larger
healthcare systems, the built environment is evolving,
particularly by moving doctors out of private offices
and into more open workspaces as a foundation for
changing processes and opening lines of communication and collaboration.
Literature review
While open workspaces are recommended to create
a PCMH, considerable literature since the 1970s
shows that using that model in traditional office
settings can actually decrease communication and
interaction if not properly designed. Designers should

consider the tasks, culture, and technology of an organization to effectively impact communication.
A research team composed of senior researcher
Jennifer DuBose and PhD graduate student Lisa Lim
from the Georgia Institute of Technology, as well as
researcher Doug Bazuin and Ross Westlake of Applied
Knowledge and Insights from Herman Miller Healthcare, was interested in the evolution of team-based
care and the ability of the built environment to facilitate
or impede it. The team developed a research program
to explore design solutions for care team rooms. The
project was selected by the Academy of Architecture
for Health Foundation (AAHF, part of the American
Institute of Architects) for the foundation's 2014 annual
research grant.
The research team reviewed articles from various
domains to identify implications for team room design.
It was found that while a variety of communication
studies had been conducted, particularly in office settings, only a few articles addressed workspace features
that support communication among healthcare teams
and there were no specific studies of settings for
multidisciplinary care teams in outpatient settings. The
lack of literature specific to PCMH-style team room
design emphasizes the importance of this project for
the rapidly emerging outpatient model.
Building from the literature and clinic observations,
a framework and model were developed for designing and evaluating the psychosocial characteristics of
outpatient team spaces and their impact on collaboration and clinical work processes. The team identified
four areas significantly impacted by design: culture,
communication, individual work, and coordination and
awareness. Additionally, specific dimensions of the
environment were broken down into those affecting
workplace communication and collaboration: proximity,
visibility, artifacts, connectivity, openness, and arrangement. Each of these dimensions describes an aspect of
the staff, their work, and their relation to each other and
elements of their physical environment.

Jennifer DuBose

Observations
While the team learned from the literature review, much
more was learned by going out into the field to observe
how teams work in different spaces and conduct interviews with key staff members in PCMH-certified clinics.
Ross Westlake

38

HCDmagazine.com 04.15
http://www.HCDmagazine.com
Healthcare Design - April 2015

Table of Contents for the Digital Edition of Healthcare Design - April 2015
